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Miscellaneous - 123 BRENTWOOD CIRCLE 4/30/2018 (2)
/tI23 BRENT01064.0-0 Cunningham Lindsey U.S.,Inc. P.O.Box 703689 Cunnin ham tv Dallas,TX 75370-3689 L1n( .Sey Telephone(888)738-8714 Facsimile(214)488-6766 CLCAT@CL-NA.COM ***********************AUTO**3-DIGIT 018 816 T3 P1 95000059006 Building Commissioner or Inspector of Buildings 120 MAIN STREET NORTH ANDOVER,MA 01845 Form of Notice`of Casualty Loss to Building Under MASS. GEN. LAWS Ch. 139, Sec 3B Claim Number: 2535912 07 Policy Number: 2535912 07 co Company Name: MERRIMACK MUTUAL FIRE INS Cause of Loss: ICE DAM Lo Date of Loss: 2/15/2015 Insured: RICHARD BLAIN Property Location: 123 BRENTWOOD CIR Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number. Section 3B.,No insurer shall pay any claims (1) covering the loss, damage, or destructions,to,a building or other structure, amounting to the one thousand dollars or more, or (2) covering any loss; damn' ge or destruction of any amount, which causes the condition of a building or other structure to render section six of chapter one hundred and forty-three applicable, without having at least ten days previously given written notice to the building commissioner or inspector of buildings appointed pursuant to the state building code, to the fire department or arson squad of the city or town and to the board of health or board of selectmen of the city or town in which the same is located. If at any time prior to the payment the said city or town notifies the insurer by certified mail of its intent to initiate proceedings designed to perfect a lien pursuant to section three A, or to section nine of chapter one hundred and forty-three, or section one hundred and twenty-seven B of chapter one hundred and eleven, the said payment shall not be made while the said proceedings are pending; provided, however, that said proceedings are initiated within thirty days of receipt of such notification. Any lien perfected pursuant to section three A, or to section nine of chapter one hundred and forty-three or section one hundred and twenty-seven B of chapter one hundred and eleven, shall extend to and may be enforced by the city or town against any casualty insurance policy or policies covering any loss, damage, or destruction pursuant to which the proceedings to perfect the lien were initiated. No insurer shall be liable to any insured owner, mortgagee, assignee, city or town, or other interested party for amounts disbursed to a city or town under the provisions of this section, or for amounts not disbursed to a city or town under the provisions of this section. On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. Cunningham Lindsey Catastrophe Department cicat@cl-na.com 800-867-3885 Cunningham Lindsey U.S.,Inc. P.O.Box 703689 Cunnlngan1 Dallas,TX 75370-3689 L1nd Sey Telephone(888)738-8714 Facsimile(214)488-6766 CLCAT@CL-NA.COM March 24, 2015 TOWN BUILDING COMMISSIONER North Andover Town Hall 120 Main St North Andover, MA 01845 Claim Number: 2535912 07 Policy Number: 2535912 07 Company Name: MERRIMACK MUTUAL FIRE INSURANCE CO Date of Loss: 02/15/2015 Insured: RICHARD BLAIN Property Location: 123 BRENTWOOD CIR, NORTH ANDOVER, MA 01845 To Whom It May Concern: Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Law, Chapter 139,Section 3B is appropriate, please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number, BUTTERWORTH & 01TOOLE, INC. ADJUSTERS/APPRAISERS FOR INSURANCE COMPANIES ONLY P.O.BOX 8294 SALEM,MA 01971-8294 TEL. (978)741-5731 FAX (978)740-9109 claimsp_butterworthotoole.com 02/02/2015 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS . GEN. LAWS, CH. 139, SEC. 3B TO: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectmen City/Town Hall City/Town Hall ADDRESSES North Andover, MA 01845 North Andover, MA 01845 RE: Insured: Richard and Kathleen Blain Address : 123 Brentwood Circle North Andover, MA 01845 Policy No. : 2535912 Loss of: 12/20/2014 Water File or Claim No . : 55-0104 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1, 000 . 00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property and we will recommend to the insuring company that this claim is paid. Vicki Gardner Adjuster I Member of National Association of Independent Insurance Adjusters Date.....? .....l.}.' . NOR71{ TOWN OF NORTH ANDOVER = p PERMIT FOR WIRING �Ss�cHusf� t , This certifies that A. Anc�w�p1. has permission to perform .... ? �T ..!�V......................................... wiring in the building of.... ..... fi . .......................................... at.............{23......... ,North Andover,Mass. . ........... lAk ELECTRICAL INSPECTOR '1 Check # & Commonwealth of Massachusetts Official Use only low . Department of Fire Services Permit No. L� Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (leaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 C R 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: Il O City or Town of: /70rt!1 A)l-)r/Orrel- To the Inspecto of Wires: By this application the undersigned gives no 'ce of his or her intention to perform the electrical work described below. Location(Street& N ber) `�3 entldGY1� �,°r Owner or Tenant A -,C eil°n Telephone No. Owner's Address CZme- Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building k Y ' )\A) Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: UU�i w) Sh —i eU roO/" ti Completion of the following table ma q e waived by the Inspector of Wires. No of o Total No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets 9�-Q No.of Hot Tubs Generators KVA No.of Luminaires 1.5 Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets � No.of Oil Burners FIRE ALARMS No.of Zones No. of Switches 30 No.of Gas Burners No.of Detection and Initiatin2 Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No. of Waste Disposers Heat Pump Number Tons KW o.o Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.o Water No.of No. of Heaters KW Data Wiring: Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under die pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC. NO.: Licensee: ` ,Ce, Po Urr) Signature' RLIC. NO.: a 90*1fC applicable, enter A 'e empt"in the license number line.) Bus. Tel. No.. )-L/ ' Address: i�/ ES;LI S'13C'* _ -f L® �'`J� ©)S.O(0 Alt. Tel. No.:tu 81 c/y— / *Security System Contractor License required for this work; if applicable,enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ ��� i l �. �� I L . Date. .6 1 "oR,,, TOWN OF NORTH ANDOVER°' p PERMIT FOR PLUMBING_ ,SSACMUS� , f This certifies that . . . � �''f�.`.�"�'. . . . . . . . . . . . . . . . . . has permission to perform . - t A :(p" . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . ... . . . . . . � . . . • . . . i= ` at . . .42.3. . . . pc t. �'!. . . . . . .,-North Andover, Mass. a Feea .SQ. .Lic. No.. ✓ . . . , ! .' '1. . . . . . . . . . . . . . PLUMBING INSPECTOR {.. Check # 7052 E ,�pRTI, TOWN OF NORTH ANDOVE op � PERMIT FOR GAS INSTALTION "'Sh �9SSACMUSES a. This certifies that . . . 1W.. . . . . . . . . . . . . . . . . . . . . . . . . . . �,� has permission for gas installation . xr.a. . . . . . . . . . . . . . . . in the buildings of . . . . TU G r,�. . . . . . . . . . . . . . . . . . . . . . . . . . . at . ./23 . ./?/�r : North Andover,.Mass.. Fee. .3. Lic. No.) 3S . . . . LL . . . .NSPEC O Check# �Gi-/ 5721 MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING (Type or print) Date NORTH ANDOVER,MASSACHUSETTS _j Building Locations 4 dJ�e n Permit# PIAAmount$Owner's Name4 New❑ Renovation r7t." Replacement ❑ Plans Submitted ❑ rA w w o U H O w a o a o z w w � z d a a w > x H z > w F, U .a v, z WwC O�l O O W O w x x w $ A C7 a U a > A a F■ C MEN ENT r BA SEM ENT i 1ST. FLOOR 2 N D . F L O O R 3RD . FLOOR 4TH FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . F L O O R (Print or type) Check one: Certificate Installing Company Name /� �1�11i2� �,�1�. Corp. Address o Partner. H G7 Business e ep one Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one/ I have a current liability Insurance policy or it's substantial equivalent. Yes No If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity 1:1 Bond 13 Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent I hereby certify that all of the details and information I have submitted('or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachu tta-S ate Gas ; d and t 142 of the General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title ❑ Plumber City/Town ❑ Gas Fitter License Number" Master APPROVED(OFFICE USE ONLY) ��urneyman MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLtiMBING (Type or print) NORTH ANDOVER,MASSACHUSETT Building Location /4-3 13,1eri t4lyv L/`Owners Name `� �I! Date Permit J# Type of Occupancy Amount New Renovation P/ Replacement Plans Submitted Yes a No ❑ FIXTURES r F Zcf > N � a 6 z A RASEY yr >ts .HDM M>I l 3M MOM 4M MOM M>� 6M FL" 71H FWOR sni FLOCIR I (Print or type) Check one: Installing Co any Named��j fty��!� l S Certificate Address 7 /�O Corp. M4 L/H ,7 Partner. ,3usniess` e ep one - 0—Firm/C0. ,Name of Licensed Plumber: J �� _� � l ^ IAA 'e"— Insurance Coverage: Indicate the t of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ® Bond El Insurance Waiver: I, the undersigned,have been made aware that the licensee of this application does not have anone of the above three insurance y Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered) in above application are true and accurate to the hest of my knowledge and that all plumbing work and installations pciformed under Permit Issued for thus a lication w' le compliance with ;ill pertinent provision;;of the Massac us°fts S e Phi a( , pp ill I ui h a chapter 14.of the General Laws. By. ,.ign urc c; .ucensc um cr Title: Type of Plumhing License � Z_ City/Town icense i um er Master ® Journeyman ��P.PaOV ED iOFFiCF,USE ONLY SEP-13-2006 05 :29 PM LARRY OGDEN 978 352 2558 P. 01 LAWRENCE H.OGDEN,P.E. 198 EAST MAIN STREET GEORGETOWN,MA 01833 978-352-8318 fax 978—352-2858 cell 978-502-5921 September 13, 2006 Mr.Kenneth Murphy fax 978-688-7207 169 Boxford Street North Andover,Ma. 01845 RE: 1.23 Brentwood Circle,North Andover Dear Mr.,Muurphy As You requested I visited the alcove site to review the LVL Beam used in the first floor of the new addition. This beam consist of 2 members 13/4"*91/4"with a span of 10 ft. 10 in. and supports 12 feet of the second floor above. This beam is acceptable and meets the requirements of Massachusetts State Building code. As related to the plumbing pipe cut thru the studs at the second floor bath room window I would suggest that you block behind the pipe with I inch spruce boards or an LVL rim board. Should you require any additional information,please do not hesitate to call. Yours truly, 0 04 Ic `"RODILawrene kI. Ogden,P.E. y � s3 DRN NAL 0 I Location a 3 No. Date NORTIy TOWN OF NORTH ANDOVER - O'q«•o aT: • • O f R Certificate of Occupancy $ s�CNUsEt� Building/Frame Permit Fee $ r Foundation Permit Fee $ r Other Permit Fee $ r TOTAL Check # 19120 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED. a, ' G /` SIGNATURE: Bifilding Conunl oner/Ina=lwr of Buildings Date SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: til., Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: uvo Zoning District T;ioposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS t1 Front Yard Side Yard Rear Yard Required Provide Required Provided. Required Provided -3b 11-N 3D p 1.7 Water Supply NMIL-C.40. 34) 1.3. Flood Zone Information: 1.8 Sewerage Disposal System: Pnblic Private ❑ Zone Outside Flood Zone Municipal On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No M 2.1 Owner of Record 77"(PrintL Address for Service: S16�aP Telephone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor:` License Number Address Expiration Date ic Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number '... ddress _r b �-3 3 S'- U1Z Si ature Telephone Expiration Date G) SECTION 4-WORKERS COMPENSATION(M:G.L.C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the bu•ding permit. -Signed affidavit Attached Yes...... No.......❑ SECTION 5 Descrition of Proposed Work check all a 4cable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: VV S �Ly vim- �'/��-vl, it �~� C��L� �n.,.-'t�•`. ��?A�/1^—� (/y`/ ` . SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be ©FFCI)ILUSEO Completed b permit applicant `' ` 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X(b) 4 Mechanical(HVAC) V 5 Fire Protection =--- ' cle 6 Total 1+2+3+4+5 ( D L V 1, Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ate`' I, as Owner/Authorized Agent of subject property authonze V6A.A) to act on ' My beh if,ih al tters relative to work autho y this building permit application. Si ature of Ov&er Date SECTIION 7b OWNER/AUTHORIZED AGENT DECLARATION I, \� �,�,.,n ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief PrVmle Si a e of Owner/A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB f3A C� SIZE OF FLOOR T ABERS 3Fmq✓((p. SPAN l DIMENSIONS OF SILLS -2 d- DIIvIENSIONS OF POSTS v DIMENSIONS OF GIRDERS t�•� HEIGHT OF FOUNDATION THICKNESS \ `` SIZE OF FOOTING d-2 ` X MATERIAL OF CHFVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE VJ() C NORTH 0'" 0f Andover 0 No. - A o �` dover, Mass, y • / yo or 10 o COCMICMEWICK V AORATEO PPp\ '9S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System • THIS CERTIFIES THAT....... 1..�r.�. 64. ...... ................... •. BUILDING INSPECTOR .. .: ... Foundation 1 has permission to�e4.. bu'dings on :.�r.3...... � .� Rough to be occupied as.%IA. r0�1: ov; . . .�.�� ...... ...ro..orw.............................. Chimney Ch' provided that the person accepting this permit shah very respect conform to the terms of the application on file in Final this office, and to the provisions of the Codesy-Laws relating to the Inspection, Alteration and Construction of a �'? Buildings in the Town of North Andover. (f & PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PENT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT>iTz TS Rough .. . ...... ..... ...... Service UILDING INSPE Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. IF-SEE REVERSE SIDE Smoke Det. ., :t--. 'a"r3- a..:1;_.� :f.{ G G:�+;. � to 'i,t, .ta; i -.':. f '::t' .,•~• ��i • � rt.. ' �-f Iii. i•r, • ! �+: �;.r•. ,! �- - r•' !C:. _;r�x�,:;-",,t. : ••: tt:r � - f" of ! ::� .!'' - .t. :[ ss:.�:.�_ ,.r rr: r;. ::.: a,♦ �� 1'is f •N: t'.'�i t = ' t � It •�, t;=.ire - ,. ,, i' ��.�;: r •ri •',t 7, • rs�, ,,�,:w-!f:'a, ❑ +�7' - .<t �':;.•. ae-[s'--.s;.L .ys r�,:.y� ,«.. �. 4 a-'. 4 WIN Al .:i [ k -:'♦".." ;f:��}: ♦a" .. t.[�:.• ♦- _,1_ •. -'� i:r.?. '.i« .}...', '+.i.sig}:' .,•t+�•ws w',:.�.. �....Y,': 'f.'s':i gin; SCOTT. L. GILES, R.RL.S. 50 Deer.Meadow Road North Andover, MA 01845 0 683-2645 3T14 11/17/2005 LINCOLN DALEY, TOWN PLANNER TOWN OF NORTH ANDOVER OSGOOD STREET NORTH ANDOVER, MASS. RE:#123 BRENTWOOD CIRCLE LOCATED/N THE WATERSHED PROTECTION DISTRICT AND APPLYING FOR A BUILDING PERMIT TO CONSTRUCT AN ADDITION AT SAME LOCATION., THERE ARE NO BORDERING VEGETATED WETLANDS, CHANNELS OR STREAMS LOCATED WITHIN 400'OF THE PROPOSED CONSTRUCTION THAT WILL OCCUR AT THIS LOCATION. IT IS THEREFORE MY OPINION THAT A SPECIAL PERMIT FILING WILL NOT BE NECESSARY FOR THIS PROJECT. VERY TRULY YO R SCOTTL. GILES R.P.L.S. r I i NORTH ANDOVER.BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: \23 is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by NIGL . i1, S150A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 1 OA. The debris will be disposed of in: (Location of Facility) -' Signature of P it licant � rr Fire Department Sign off. ✓-yckG, 4Q, 1 1y Go-► �i�G�a� s Trek Dumpster Permit Date i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street :II � °s= / N Boston MA 02111 b www.mass.gov/dia ' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/lndividual): Address: '� `� � �. S - City/State/Zip: d�-ti, V 1�'6Phone #: '"1 66, -53 S 5 A;W10arn u an employer?Check the appropriate box: Type of project(required): I. a employer with 3 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. + 7• ❑ Remodeling ship and have no employees These sub-contractors have 8: ❑ Demolition workingfor me in an capacity. workers' comp. insurance. Y p tY• 9 ,Building addition [No workers' comp. insurance 5. El We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No* workers' comp. C. 152,''I(4),and we have no 12.❑ Roof repairs r insurance required.]t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#I must also till out the section below showing their workers'compensation policy information. p, rlomeowners who submirthis affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors that check this box must attached an additional sheet showing the name of the siib-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: y. pVqq I.. Policy #or Self-ins. Lic. 6�q 4b Ll-uz_ Expiration Date:__ �3 ±1— c Job Site Address: r �v w.s��, City/State/Zip: k&. r�•�,,,,��,, G ��� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. i I /do here y_certi under the pai'f.,` l penalties u ' erjury that the information provided above is true and correct. Si nature. cW�, -- _ Date: k 2 'b Phone It: 0\'1 Y) Ii O/Jic•ial use only. Do not write in this area,to be completed by city or town ulfic•ial. City or Town: Permit/License# Issuing Authority(circle one): I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other i Contact Person: Phone#: r Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." GAn employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, $25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have i employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confinnation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials ` Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to till out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in __(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 0211.1 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia I C> ! 169 Boxford Street North Andover,' '—''� �� • PH 978-68M335 A 01845 Building Contractor FAX:978-688-7207 I Proposal To: Rick&Kathy Blain 123 Brentwood Circle All Hone improvement Contractors and Suboontractors engaged in hone improvement contracting,unless North Andover, Ma. 01845 specifically exempt from registration by Provisions of Chapter 142A of the general laws,must be registered with the Commonwealth of Massachusetts.Inquiries about registration and Status should be made to the Director,Home Improvement Cadract Registration,One Ashburton Pleoe, From: Kevin Murphy Roan 1301,Boston,MA 02108.(617}727 8598 cc: Date: 10/14/2005 Job: Mudroom/Study/Master bedroom addition Date of plans: 2/05 Architect: Gavin&Sullivan Location: same Section 1-Work Schedule Contractor will begin the work or order the materials before the third day following the signing of this agreement, unless specified here in writing contractor will begin work on or about 11/15/05. Barring Delay caused by circumstances beyond Contactors control,the work will be completed by 5/15/06.The owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall no be considered as violations of this agreement. Section 11-Warranty The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of 1 year followingcompletion and shall comply with the requirements of this Agreement. In the event an defect in workmanship or materials or p pY req 9 Y p damage caused by the Contractor, his subcontractors, employees or agents, is discovered within one year after completion of any job, including cleanup,the Contractor shall,at his own expense,forthwith remedy,repair correct,replace,or cause to be remedied,repaired,or replaced, such damage or such defect in materials or workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. Section 111—Scope of Work ,r MeviiM MMUP lny Page 2 of Building Coat:actos 1698o) dStreet Mora,Andover,MA 01845 PH:9786865335 FAX 978-6Wp000 General Building permit will be provided by contractor. No allowance has been made for conservation, board of health, or variance approvals if required by town, Price is based on plans as shown with the exception of mudroom. Proposed mudroom will run along rear wall of garage, and stop approximately two feet before end of garage wall. Roof on mudroom will mirror garage. Second floor of existing house will have two A-dormers built as shown on plans. Existing second floor bathroom will be remodeled,fixtures to remain in same locations.Closets in existing master bedroom will be built on both sides of new dormer. Second existing bedroom to be renovated as shown on plans. Second stairway to second floor will be deleted. Demolition Roof over existing family room will be removed. Excavating Excavation required to install crawl space foundations for study and mudroom additions will be provided. Backfilling and rough grading will be provided. Any additional fill will be removed from site. No allowance has been made for removal of ledge, landscaping, lawn installation, or any sprinkler systems. Foundation Poured concrete foundations will be provided for study and mudroom additions. Concrete cutting will be provided to gain access to new crawl space basement area under study. Rough concrete slabs will be poured in new basement areas. Building All frame, roof, and siding materials will be supplied to match existing/meet building code/as shown on plans. All floor,wall, and roof sheathing will be plywood. (3/4 on floors, 1/2 on walls,518 on roof)Floor joist size to be determined, walls will be 2x4, roof rafters will be 2x8 or 2x10. Entire front of existing house will be stripped and reroofed. Shingles to match existing. Ice&water sheild will be installed at all roof edges, valleys, and any roofs under a 4/12 pitch. Cedar siding will be supplied and installed to match existing, over Tyvek or equivalent. Anderson windows will be supplied and installed as shown on plans. Exterior steel door units will be therma-tru or equivalient. Plumbing Plumbing required to install new five fixture master bath,add laundry connections on second floor,and renovate existing second floor full bath will be provided.An allowance of$2650 has been included for plumbing fixtures.( $150 per faucet,$200 per toilet,$500 per tub/shower,$100 per shower/tub valve). Electrical Electrical work required to wire addition to meet code will be provided. Fifteen recessed lights have been included. Additional recessed lights can be added at a cost of$75 per light Phone, cable. and computer lines will be roughed-in by electrician, to be connected by their service provider. General layout to be approved by owner prior to rough. Existing electrical service will be upgraded to 200amp. Surface mounted fixtures to be provided by owner.(ceiling fans etc.) Heating/Air Conditioning i Kevin Rr 1mrPRay Page 3 of Banding Contractor 169 ftdord sweet Nath Andover,MA 01845 PH:9786885335 FAX 978688x)00( All added areas will have forced hot water heating installed . First floor zone will be extended into new study area. A separate zone will be added for master bedroom. Existing boiler to be replaced with Burhnam or equivalent, sized to properly heat all added / renovated areas. No allowances have been made for any air conditioning. Insulation All added/renovated areas will be insulated to meet code. ( R-19 in cellar ceilings, R-13 in exterior walls, R-30 in ceilings) Plaster All added/renovated areas will be blueboarded and skimcoat plastered. Ceilings to match existing,walls will be smooth,closets will be textured. Interior Trim/Doors All pre-primed interior trim and doors will be supplied and installed to match existing. No allowance has been made for any built-in cabinets. Painting There have been no allowances made to provide any painting. Any painting will be provided by owner. Flooring Hardwood flooring will be provided in new study, and second floor hallway. Tile floors will be installed in new mudroom, master bathroom, laundry room, and existing bathroom on second floor. An allowance of$1500 has been included for file materials.An allowance of$3000 has been included to supply and install carpets in added and existing bedrooms. Other Allowances An allowance of$2500 has been included for vanities and countertops. Existing brick chimney will be extended as required to clear new roof structure. Brick to match existing as available. An allowance of $2000 has been included to supply and install two new insulated steel arae doors and pP Y garage openers. Waste Removal All demolition/construction debris will be disposed of by contractor. Items Not Included No allowances have been made for renovations to other parts of existing house, landscaping, lawn installation, air conditioning, built-ins, or shower doors. r Page4 of 4 Bniidfngt Contractor 169 Boxford street Nath Andover,MA 01845 PH:97818853.35 FAX 978188-X)00( Section IV—Price Schedule We hereby propose to furnish material and labor—complete in Accordance with above specifications for the sum of... ... ...... ... ...... ... ... ... .......$ 180,000 Payment to be made as follows: Percenta e/ltem Description Amount 1 Permit obtained $3000 2 Foundations corn tete $25,000 3 Roof framing on mudroom / masterbedroom $40,000 4 Roofing complete $20,000 5 Siding /Windows installed $30,000 6 Rough plumbing / electric complete $151000 e 7 Plasteringcomplete $15,000 lora: P ,;1(1 8 Interior trim / painting complete $10,000 /0 9 Flooring complete $10,000 10 Job 100% complete $12,000.00 Total 10 $180,000.00 Notice:No apwnent for Fbme improvement contracting work shall require a down payment(advance deposit)of more that oro*rd of the total Conhxt price of the total artrouM of all deposits or payments which the contactor must make,in advance,to order ardor otherwise obtain delivery of special order materials and equipment,whichever is greater Contractor: Kevin Murphy 169 Boxford Street No.Andover, MA 01845 Registration No: 101874 Section V-Acceptance Acceptance of Proposal—I have read this document and accept the prices,specifications,and conditions stated. I understand that upon signing,this proposal becomes a binding contract.You are authorized to do the work as specified. Payment will be made as outlined above. You the buyer may cancel this transaction at any time prior to midnight on the third business day after the date of this transaction cancellation must be done in writing DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Signature Date %O Zy OS— er Signature Data I'VI'(m U - LV I KCLGAQC rvrRm INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtaineplLsldc!e�not relieve the applicant and/or landowner from compliance with any applicable or requirements. OC , .� APPLICANT FILLS OUT THIS SECT COMMUNITY D VELOPME T I V APPLICANT l•- ��. PHONE 1 3 LOCATION: Assessor's Map Number PARCEL K"NaMED SUBDIVISION LOT(S) r ' STREET ST. NUMBER COMMUNITY KA/11_rk•+A. OFFICIAL USE ONL E MM CTI TO GENTS: CON ERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS 1 TO PLANNER DATE APPROVED DATE REJECTED — t COMMENTS ti FOOD IINSPE OR-HtAl TH DATE APPRO D DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT I FIRE DEPARTMENT All Pti,�►, >?'S feJ niG.l :"ECEIVED BY BUILDING INSPECTOR DATE Rw196d 9197 JM l Location • °if L1t ` L No. Date r f 40RTM 1 TOWN OF NORTH ANDOVER �. 0 a I Certificate of Occupancy $ Building/Frame Permit Fee $ + ��s" <� Foundation Permit Fee $ SACHUSE Other Permit Fee $ Sewer Connection Fee $ ' Water Connection Fee $ r � � e„ TOTAL $ . ,4 .,/''Building Inspector Div. Public Works and Location No. Date ` . :w MORTh TOWN OF NORTH ANDOVER `r y p ` Certificate of Occupancy • d�ad o �+ Building/Frame Permit Fee $ ra�sE�� Foundation Permit Fee $ ;i Other Permit Fee $ -y Sewer Connection Fee $ Water Connection Fee - $ TOTAL 6d,t�'t s�sY p /Building Inspector 1 G Gr Q. Div. Public Works f 1'1'RMIT NO. 3(_5 AI'I'LICATION I,OIZ i'Z RMI'F TO IIUILI)*** ***NOIZTII AND0Vr17, MA �( 4 /_/J I oT.NO. 2. HECl1HbOf ox%,rq I(slnl. 1)1%1'E BOOK PAGE M%I,NO. 10 l 7,Ilht: Still DIV. LOT ND. AT ION /Z3 PI1RIYl5ElX Illlll 1)I N(: r �rTCtfP�t/ Sv.(J �f1 / I uwv / fARt N'NER�SNMIL -J NO. Of STORIES SIZE /N )WNER�S ADDRESS BASEMENT(N2 SI.AD9� CSIZE OFFI.00RIINIIIERS 2 3 '1111 EC-I'S NAME HIM DER's N.4AIE SPAN DISI ANCE TO NEAREST 13UII DING DIMF:NSI(NJS OF Sit I.S DIS DANCE I-ROM STRFF-I DIMENSIONS OF POS I S DIS DANCE FROr�1 I.Or LINES-SIDES REAR DIMENSIONS OF GIRDERS - AREA OF LOT rR(NJ rAGE. I IEIGIrr Of FOUNDATI(NJ TI IICKN[SS SIZLOr 1(X)TING X IS W III.DING NEW IS IIIIILDING AI)UI rIINI MATERIAL OF Cl II1,INEY IS BUILDING ALIERATI(Nl - IS BUII.DING(Nd SOI II)OR FII LED LAND ,111 I.BUILT)ING CONFORM TO REQl 11 REMEN I S CN=COOE IS B(IILDING CNJNLCI ED 10 TOWN WA'fI-R til .-NRDOF APPLAIS ACTION, IF ANY IS B1111.1)INGCONNECT ED 10 1OWN SEWER IS BUILDING CONNECTED TO NAI URAL GAS I1NE INSTII('-TIONS 3. PROPElil'Y INFl URAIAl ON LAND COST ESI BITx;. COST PAGE I Fill.CXIf SECTIONS 1-3 EST. BI IX;.COST PLR SQ. Fr. ESI. BI.IX-i: COSI PER R(X)ti ELECTRIC METERS MUST BE ON(ATTSIDE OF WILDING SEPl1C PERMI f NO. .AFIACIIEDGARAGESMUST C(N`7FORM fOsrATE FIRE REGULA11(NJS 4. :\1'1'ItO%'k.D BY: PLANS MUST BE FILED ANT)APPROVED BY BUILDING INSPECTOR BUILDING I1.IIINC INSI'F.CTOR u `� OWNERS 1 F:I.N DAIEFIIED C/ ✓✓✓ 9 >� . / C(NJIR.IELN V/ 2,e,.�( N �- CO ,R.I.IC-{I n 1/+ j� SiGNA1tlRIiOFOWNI:RIMt fI1K)Vil'Llil)AGLNf HVl7 I'I.RAIITGRANITI) OVX -7 lab 3p130/30 The Commonwealth of Massachusetts Department of Industrial Accidents -- Office e110801298fis 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit i name_ Lcd1a t> R. ;4 1 j location12-3: � � kV C!gje - am a homeowner performing all work myself. 17 I am a sole proprietor and have no one working in any capacity C] I am an employer providing workers' compensation for my employees working on this job. ss9mce�ry ramex. - ,, address.:.;: phone#., insaranee cv: policy# 0 I am a-sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers'compensation polices: compLny name*:*: address.:: . city `phone#: .a.w insurance so: PON r� company name I iaddress.. I ci phone#: Ii m�nranee co.. y-o;icf# Failure to secure coverage as required under Section 25A of MCL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby cerci nder the pain d penalties of jury that the information provided above is true and correeccL Signature Date 0 /v Print name !<LG }2• �1c}t/V Phone# 7�'17 ��7� official use only do not write in this area to be completed by city or town official city or town: permit/license# fl Building Department []Licensing Board 0 check if immediate response is required []Selectmen's Office []Health Department contact person: phone#; nOther (revised 7/95 P1A) i i I Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption (Please print). DATE 1 JOB LOCATION Number Street Address Section of town 'PHOMEOWNER"_ �ICjjy�ai� �� ��iN —��y� �e3--63,44.3 Name Home Phone Work Phone PRESENT MAILING ADDRESS /00- YN . City own State Zip code The current exemption for "homeowners" was extended to include owner occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code, Section 109. 1 . 1) DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside , on which there is , or is intended to be, a one to six family dwell- ing, attached or detached structures accessory Lo such use and/or farm structures . A person who constructs more than one home in a two-year period shall not be considered a homeowner . Such "homeowner" shall submit e to the Building Official, on a form' acceptable to the Bulding Official , khat he/she shall be responsible for all such work performed under the IDuilding permit . (Section 109 . 1 . 1) F The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes , by-laws , rules and .,(�gulations . !e undersigned "homeowner" certifies that he/she understands the Town of Lh Andover Building Department minimum inspection procedures and . :quirements and that he/she will comply with said procedures .and requirements . ')MEOWNER' S SIGNATURE&(a_-4� 'PROVAL OF BUILDING OFFICIAL jte: Three family dwellings 35 ,000 cubic feet , or larger, will be required to comply with State Building Code Section 127 .0, Construction Control . i TOWN OF NORTH ANDOVER I AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units...or to structures which are adjacent to such residence or building" be done by registered contractors, with certain exception, along with other requirements. Type of Work:_V_TchU/ ¢ Sya Pazy ftJy\11y;aL,�?.^>D 7,0uEst. Cost © 0� Address of Work Owner Name: A iCjh yL i3I gtA) Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): For office Use Only Work excluded by law Pemit No. Job under $1,000 Date Building not owner-occupied _Owner pulling own permit Other (specify) Notice is hereby _given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND LINER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name w� w..w-- FORM U - LOT RELEASE FORM 1' INSTRUCTIONS: This form is used to verify that all necessary approvals/per"from . Boards and ^--partments having jurisdiction have been obtained. This does not relieve .the applicant and/or landowner from compliance with any applicable or requirements, APPLICANT FILLS OUT THIS SECTION T APPLICANT PHONE/ LOCATION: Assessors Map Number PARCEL SUBDIVISION LOT(S)j :i. b �. STREET E C112cST. NUMBER 1 ----------------------- """OFFICIAL USE ONLY I RECOM DATIONS OF TOWN AGENTS: • ERVATION ADMINISTRATO DATE APPROVED l DATER JECTED COMMENTS IBJ c rL c 0 ' F. Al TOWN PLANNERs DATE APPROVED r DATE REJECTED COMM TS �r FOOD INSPECTOR-HEALTH DATE APPROVED I DATE REJECTED i j SEPTIC INSPECTOR-HEALTH DATE APPROVED I DATE REJECTED COMMENTS PUBLIC WORKS-SEWERIWATER CONNECTIONS I DRIVEWAY PERMIT FIRE DEPARTMENT I ' RECEIVED BY BUILDING INSPECTOR DATE i 604-59--40E 50rb'3�-20E - '3?). 2. - -7Z 03, 6o S4 LOT -1` ►0 44 , 000 ,-5F all,� (u N S c+uMWY 43.37 .2 5'7'-y WFD 33.24 /.Z3 N arES 1),DWEI-.L.1N G Loc-A-T1anl FRoM AN i NSTRUMENT .SURVEY. _ o z � 9 E.N. . r D )SEE PLAN 4g6 D FOR PROPERTY ERTY LINJE - REFERENCE TO 51TE-. � - 1 F 1 150.00' 505--t5-Z2E 8REI-I T1/\JOOD CIi \C LE tt+o>`ncq PLAN OF- L-AN p M & NO A NOOVE r? , A S NOF . R.1 CHAR D BLA)NE 5HOVVINQI E1CISTINC� .DWELLING w(-A-TION 0 30 60 120 JEF S. HOFM N -6o� Ati�,I�TRS �lE.P.P�ijl.9Gt'E".VG�•f'/EE.P/.(/G SE.Pv/lEs' 6(0 �q.P�,ST.PEET A.VODYE.P, �YJ.4S,S,4C.f�//SETTS O/8/O 3331 Date., � ��9. .... NORTH TOWN OF NORTH ANDOVER Of ao 1 -1 16 0 "� `p PERMIT FOR GAS INSTALLATION 9 9SSACHUSEt This certifies that . _`. -. . . . . . . . . . . . . . . . . . . . . has permission for gas installation . ,,!�. �.�:.,� c . . . . . . . . . . . . . . . in the buildings of . . . <!-?! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . �. . . .lJ.�3 `�. ?��. . .C ! ;North Andover, Mass. Fee. No.. -,I-.x.3 3. . . . . . . . . . . . . . .. . . . . . GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPUCATION FOR PERMIT TO DO GASFITTING (Print or'Type) JV 17Y1 �1�Y'/Y' , Mass Date 19,� Permit # 33 Building Location J,79, _ Mwner's Name 14 fg4 /4/& Type of Occupancy_ FR E51 7(:�N T r ri 7 New ❑ Renovation [3 . Replacement Plans Submitted: Yes❑ No ❑ _ N Z ¢ ¢ tl '� W 0 V ¢ F < } = Z C f tL < m N r, y W O d �' ¢ W < (� to < N rC fA tl V W N Z < ¢ tl O W tl �- Vj Z J H Y �., W 'Wo > W 1- V J W < W M W Z < c- h' V rA m0z O Z 0 tll S < W > ¢ W 2 Z. < ¢ _< SUB—SSMIT. BASEMENT ISTFLOOR 2NDFLOOR 3RD FLOOR _ r. c 4TH FLOOR f STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name "ACAE7(Z T A . `elm MA T A(20 Check one: Certificate Address 3 Q OLA C H/V%A Ili i-Ki , ❑ Corporation 01 " 7 N U e n) 111 A 0 ❑ Partnership Business Telephone 692 -(71?-71 2/rm/co Name of Licensed Plumber or Gas Fitter_1�0(AE P T A- 5AMM 1q TAIL) ) INSURANCE COVERAGE: I have a current jabiltty insurance..policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes G?' No ❑ If you have checked,yes, please Indicate the type coverage by checking the appropriate box A liability insurance policy '�7. ' Other type of indemnity❑ Bond ❑ OWNER'S INSURANCE WAVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the pe ' 1 ed for this application be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ne Laws. T% f license: �3 mber ure o licensed u Title or atter er License Number 8333 City/Townurneyman N BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING ' I NAME A TYPE OF BUILDING ` LOCATION OF BUILDING I PLUMBER OR GASFITTER LIG NO. � I PERMIT GRANTED DATE I � ' GASINSPECTOR Lid S N2 2 1 01Date..... + 6 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING 'ACHUS This certifies that ..... ..0t.... ................................................ .I has permission to perform ...... k ......... ............. wiring in the building of....... kc�..k ......A.......................................................... .... .. at.... ....... .......... .North Andover,Mass. Lic.No. Lw�............................................................... ELECTRICAL INSPECTOR d 10727/98 09:26 40-00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer TBFC0 0NWFALTHOFMAWCHUS 77120 Office Use DEPARTA&WOFPUBLICS4FM Permit No. (� 1 BOARDOFMEPREVEMONREGUTATIOAN527CA FA4 Occupancy&Fees Checked PPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat 7� Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) L a13 13,1, �`/7 C� �Li/�/?G/ L Owner or Tenant Rj c-in ,) d Owner's Address .5.'46:;1 � Is this permit in conjunction with a building permit: Yes FLI No (Check Appropriate Box) Purpose of Building �" �2y�L 4 ' HelC,/5 G' Utility Authorization No. Existing Service ` (�U Amps.L / zvolts Overhead Underground ®� No.of Meters New Service Amps Volts Overhead Underground No.of Meters Number efFeeders and Ampacity Location and Nature of Proposed Electrical Work /T i'-IL c-e'/--�`' o�-Sy✓t� �� L1 ■ 1 No.of Light ng Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures d Swimming Pool Above Below Generators KVA groundground No.of Receptacle Outlets / 0 No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch 0%"s 16 No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices Ne. ashers Space Area Heating KW No.of Sounding Devices �f No.of Self Contained Detection/Sounding Devices No.of Drpr rs Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER hstrartoeCoverage Ptttsuanttiotheragtrnanat�afNiassattstG Laws lhawamnatLiabtldyh um=PnhyatridirgCarr I*OpwdmCmuaaeoritsakst3 alac}tivalatt YES © NO limeahnimadvaMproofofsamiothe0ffim YES [n NO Ifj uharechadcedYESpkmmdcwthetyWofwmaWbydeckirtgthe INSURANCE ® BOND F-1 OTHER M ftweSpe*) E��on Date EstirnaWdvahteaf�]ecwd Wak$ WcrkiDSm o a 1spx0mD*Ra pesW Rough FM FIRMNAME r7� /- C • l'G U=lseNa �~ f�'T('S' Licatsee To iD7y SGS 7 Sigtaae Iio mib !� S�S'S w / ■ rl�.r o�� WGc�c .mac 6 .57- BtsimTdNo. �/7 �u1 5-'JG30 Sc ��� !J�`GL �/�9 c,2iy3 ?.ddr��, ,,,., .—■-- Ah.Tel Na OWNER'S INSURANCEWANER;lamawarethattheLi=edore not $remstxa=o7mapordssksWntWepvabtasmgLmWbyMassadgs&GareriLaws atdiAmysoreumcnthsporniwai%tstht tries t. (Please check one) Owner M Agent LJ v ,1� �—" Telephone No. PERMIT FEE, Date. N2, r;r NORTH °'� � ° ►�"o TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING s,r° ACHUS This certifies that ` has permission.to perform plumbing in the buildings of . . . . , . . . . , CP.. . . . . . . North Andover, Mass. } Fee.d?�,--'. . .Lica No...'7.. r' PLUMBING INSPECTOR -05/02/97 08:57 25.00 PAID r . WHITE: Applicant CANARY: Building Dept. PINK:Treasurer (('rinl or Type) •T NORTH ANDOVER .Ip 97 � Mass. Oats Btrlidlnp Permll Location Owner'a t Name �rr✓ < UL� New Cl Renovallon ❑ Replacement [id Plant Submitted: Yes❑ No ❑ FIXTUNE3 ..... . sis Ma s 04 Is 0 • Oi a1 r M ~ w t' U �MR M < M = t H K M 7r R < M a X < M A O J O 0 .� a 66 K N U M ►- _ `O OO .a >< ~ K K M < of o u M w O o Ile = h M is • A e r 1• R w 0U•-11 t1 MT. aAIRM[NT r 16T FLOOR 11401 Plo0It 311D FLOOR 4TH FLOOR ITN FLOOR •TN FLOOR 1TN FLOOR Le--T), PLO OR Ch k one: Carllncate Installing Company Name ANDOVER PLG . & HEATING CO. , INC . Corp. 2 12 2 Aridrese 573 112 SQ-- UNION ST ❑Partnership LAWRENCE , MA. 01843 ❑Firm/Co. Business Telephone 508 685-8383 Flame of Licensed Plumber GEORGE LAROSE INSURANCE COVERAGE: ecx e I have a current Ilabiny Insurance olcy or Re substantial equivalent. Yet No Q It you have checked yam, please Indlcate the type eorierage by chackklg Ilia appropriate box. A Itabiny insurance pollcy L7 Other type ot Wamndy ❑ Bond ❑ OWNER'S INSURAflCE WAIVER: I am aware that the licensee doyi not have the Insurance coverage required by Chapter 112 d the Was. General Laws, and that my signature on We permit application waives this requirement. Check one: Owner C1 Agent ❑ nature ol Carnet or tomer t enl I heitby csrtlfy that all of the daWs and Inlormallon I have submitted lot tn(of"In abow appkatlon we true and &=mate to the best of my knowledge and that al plumbing woik and InstiWtons Wormed rxidei the permA It.swd lot UhLa appllaatloe m7 be in compliance with aA perilnenl provisions of the massachusatis Stale Phanbkip Code and chavise 112 of ftw Genet .� 13Y na • Tltla _ _ City/sown Uansa fbm1>w 9983 Type of Plumbing License: Mailer A"11-PA0 (NFKE 115E 0110) Jowneyman Q